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Enhanced Recovery After Surgery (ERAS) pathways have improved clinical outcomes, cost-effectiveness, and patient satisfaction across multiple non-cardiac surgical specialties. Since the adaptation of ERAS in cardiac surgery is rapidly increasing yet still evolving, herein, we demonstrate early results of our implementation of ERAS cardiac guidelines. We retrospectively reviewed all patients who were managed with our institutional ERAS Cardiac Surgery guidelines between 5/2018 and 6/2019(N = 102). Postoperative primary outcomes (total ventilation times(hours), intensive-care unit(ICU) stay, and postoperative hospital length of stay (LOS)) were compared to 1:1 propensity matched controls from the pre ERAS era between January 2017 and March 2019. A total of 76 propensity-matched pairs were identified. Compared to the matched controls, ERAS patients had significantly shorter median ventilation times(3.5 vs. 5.3 hours, p = .01), ICU stays(median 28 vs 48 hours, p=.005) and postoperative hospital LOS (median 5 vs. 6 days, p = .03). There were no operative mortalities and no significant differences in 30-day readmission rates. There were also no significant differences in post-operative stroke, acute kidney injury, atrial fibrillation, and reoperation rates for bleeding. Two-year survival was also not statistically different between the two cohorts (p = .22). Our initial experience with implementation of ERAS protocols in cardiac surgery appear to demonstrate that these protocols are associated with shorter ventilation times, ICU stay, and hospital LOS without compromising patient outcomes. While these results are promising yet preliminary, further studies are warranted to demonstrate whether ERAS algorithms in cardiac surgery can consistently expedite postoperative recovery and improve outcomes.

OBJECTIVE To systematically review the literature on the effect of dual-task testing on the balance and gait of people with lower limb amputations (PLLA). LITERATURE SURVEY Databases MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and Scopus were searched in duplicate (inception to December 1, 2020). METHODOLOGY Inclusion criteria: participants were adults with transtibial, knee-disarticulation, transfemoral, or bilateral lower limb amputations; balance or gait was paired with a secondary task; and studies were peer-reviewed and published in English. Two authors independently reviewed articles and consensus was required. A standardized data extraction sheet was used to gather study relevant information in duplicate. Methodological quality of reporting was examined using the Downs and Black Scale. A meta-analysis was unable to be performed owing to substantial participant and protocol heterogeneity among the studies included. SYNTHESIS Of 3950 articles screened, 22 met inclusion criteria. Four assessed dual-task balance and 18 dual-task gait. During single-task standing, PLLA demonstrated higher sway distance and sway velocity than controls (CN); however, a greater dual-task effect was observed only for sway velocity. Gait pace, rhythm, variability, asymmetry, and postural control were observed to be worse in PLLA relative to CN during single-task. Dual-task gait testing resulted in a disproportionally reduced pace and rhythm and increased asymmetry in PLLA compared to CN. CONCLUSIONS People with lower limb amputations have impaired balance and gait, which is affected by dual-task to a greater degree compared to healthy adults. An examination of how PLLA-specific factors such as level of amputation, reason for amputation, and experience with a prosthesis affect dual-task performance has not yet been thoroughly explored. Future research should continue to characterize the cognitive-mobility link to better understand the challenges associated with the use of a prosthesis.

INTRODUCTION The 4-wheeled walker is intended to enhance balance and gait for older adults. Yet, some research suggests that walking aids increase falls risk. An understanding of the influence of age with walker use on gait performance is required. OBJECTIVE To examine the effect of initial 4-wheeled walker use on spatiotemporal gait parameters between younger and older adults. DESIGN Cross-sectional, repeated-measures. SETTING Community-dwelling. PARTICIPANTS Twenty-five younger (age: 26.5 ± 4.1 years) and 24 older (age: 68.5 ± 10.5 years) adults participated. Younger adults were aged 18 to 35 years, whereas older adults were 50 years or older. Included were people not requiring the use of a walking aid, and those able to converse in English. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Gait velocity and stride time variability were recorded using accelerometers. Gait was examined under three conditions: unassisted walking; walking with a 4-wheeled walker; and walking with a 4-wheeled walker while completing a secondary task. Conditions were performed across two walking paths: straight and figure-of-8 Walk Test. Separate mixed-methods analyses of variance (ANOVAs; within-subject: condition/path; between-subject: group) were used for statistical analyses. RESULTS Velocity was lower when walking using a walker while completing a cognitive task (p

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a particular coronavirus strain responsible for the coronavirus disease 2019 (COVID-19), accounting for more than 3.1 million deaths worldwide. Several health-related strategies have been successfully developed to contain the rapidly-spreading virus across the globe, toward reduction of both disease burden and infection rates. Particularly, attention has been focused on either the development of novel drugs and vaccines, or by adapting already-existing drugs for COVID-19 treatment, mobilizing huge efforts to block disease progression and to overcome the shortage of effective measures available at this point. Areas covered: This perspective covers the breakthrough of multifunctional biomimetic cell membrane-based nanoparticles as next-generation nanosystems for cutting-edge COVID-19 therapeutics and vaccination, specifically cell membrane-derived nanovesicles and cell membrane-coated nanoparticles, both tailorable cell membrane-based nanosystems enriched with the surface repertoire of native cell membranes, toward maximized biointerfacing, immune evasion, cell targeting and cell-mimicking properties. Expert opinion: Nano-based approaches have received widespread interest regarding enhanced antigen delivery, prolonged blood circulation half-life and controlled release of drugs. Cell membrane-based nanoparticles comprise interesting antiviral multifunctional nanoplatforms for blocking SARS-CoV-2 binding to host cells, reducing inflammation through cytokine neutralization and improving drug delivery toward COVID-19 treatment.

Background: Walking aids are often introduced to older adults to enable independent mobility. Single-point canes are the most common device used. Benefits are tempered by research suggesting that walking aids increase fall risk. A better understanding of the effect of walking aid use on gait performance is required. Objective: To evaluate differences in the effect of initial single-point cane use on gait between younger (YAs) and older adults (OAs). Design: Cross-sectional. Setting: Community-dwelling. Participants: Twenty-six YAs (mean age ± standard deviation [SD]: 23.7 ± 2.8 years) and 25 OAs (mean age ± SD: 70.8 ± 14.1 years) participated. Inclusion criteria were 18 to 35 years of age for YAs or ≥50 years for OAs, be able to ambulate unassisted, and without any condition affecting mobility. Interventions: Not applicable. Main Outcome Measure(s): Gait velocity and stride time variability under different walking path configurations (straight path, Groningen Meander Walking Test, Figure-of-8 Walk Test) and conditions (unassisted walking, walking with a single-point cane, and walking with a single-point cane while completing a cognitive task) were recorded in a laboratory. The arithmetic task of subtracting 1s from 100 was used as the secondary cognitive task. Data analysis included separate three-way mixed analyses of variance (ANOVAs; path/condition/group). Results: There was a statistically significant two-way interaction between walking path and condition for velocity (P

Sexually transmitted infections constitute a gateway for the human immunodeficiency virus by the presence of ulcerations and local inflammatory manifestations, thus increasing the risk of transmission. The aim of the study was to assess the sexual behavior and syndromic management of sexual infections among female sex workers in the Kadiolo circle. Material and method: This was a descriptive cross-sectional study carried out in the Kadiolo circle from January 1 to December 31, 2014. It focused on clandestine or posted sex workers, aged 15 and over. Results: We collected 465 sex workers aged 15 and 49, aged 26.6 on average and from Ivory Coast 52%, Nigeria 26.2% and Mali 9.7%. Educational attainment was higher with 2.4%. Posted sex workers represented 92.5% and housed in brothels with a stay of 6 months with 53.3%. They were single with 70.8% of cases and about 72.9% lived alone and without a spouse. The age at first sexual intercourse was between 15 - 19 years with 76.6% of cases. The number of first commercial sex was between 15 - 19 years (26%) and 20 - 24 years (45.8%). Usual condom use with regular sex partners was 22.1%. Condom use was almost compulsory at 89.7% with occasional clients or non-regular sexual partners. The average number of clients per day was five (5). The major reason for consultation was vaginal discharge 16.4% followed by abdominal pain. The human immunodeficiency virus test was not compulsory and only 86 workers or 18.5% accepted with a positive result of 11 people or 12.8% of cases. Conclusion: Sexually transmitted infections are common especially as they affect young people.

Background Balance and gait problems are common and progressive in dementia. Use of a mobility aid provides physical support and confidence. Yet, mobility aid use in people with dementia increases falls three-fold. An assessment tool of mobility aid safety in people with dementia does not currently exist. The objectives of this study were: 1) to develop a tool for the evaluation of physical function and safe use of a 4-wheeled walker in people with dementia, and 2) to evaluate its construct and criterion validity, inter-rater and test-retest reliability and minimal detectable change. Methods Healthcare professionals (HCP) experienced in rehabilitation of people with dementia participated in focus groups for item generation of the new tool, The Safe Use of Mobility Aid Checklist (SUMAC). The SUMAC evaluates physical function (PF) and safe use of the equipment (EQ) on nine tasks of daily life. Reliability was evaluated by HCP (n = 5) scored participant videos of people with dementia (n = 10) using a 4-wheeled walker performing the SUMAC. Inter-rater and test-retest reliability was assessed using intra-class correlation coefficients (ICC). Construct validity evaluated scores of the HCPs to a consensus HCP panel using Spearman’s rank-order correlations. Criterion validity evaluated SUMAC-PF to the Performance-Oriented Mobility Assessment (POMA) gait subscale using Spearman’s rank-order correlations. Results Three focus groups (n = 17) generated a tool comprised of nine tasks and the components within each task for physical function and safe use. Inter-rater reliability was statistically significant for SUMAC-PF (ICC = 0.92, 95%CI (0.81, 0.98), p p p p s = 0.84), but not EQ (rs = 0.39). Conclusions The focus groups and research team developed a tool of nine tasks with evaluation on physical function and safe use of a 4-wheeled walker for people with dementia. The SUMAC tool has demonstrated content validity for the whole scale and good construct and criterion validity for the SUMAC-PF and SUMAC-EQ. The subscores of the SUMAC demonstrated excellent to good inter-rater and test-retest reliability.

Objective Postinfarction ventricular septal defects (VSDs) is one of the serious mechanical complications of acute myocardial infarction and it is associated with high mortality even with surgical repair. Combining surgical patch closure with an Amplatzer septal occluder device (ASOD) is a novel technique that has not been reported before. Deploying an ASOD under direct vision through a left ventriculotomy followed by exclusion patch repair is a novel and dependable surgical technique of a repair for patients with postinfarction VSD. Methods This is a case series of two patients with large inferior postinfarction VSDs who underwent open repair with an ASOD deployed under direct vision through a left ventriculotomy followed by surgical exclusion patch repair. Results There was no immediate intraoperative complication from the repair, no residual VSD, no in hospital mortality. One patient was taken back to the operative room for bleeding on the day of surgery. One patient was discharged to a rehab facility and the other was discharged home. Both patients continue to do well after hospital discharge without any residual VSD. Conclusions Coupling the patch exclusion technique with an Amplatzer septal occluder device for the treatment of post infarction ventricular septal defect is a novel technique with excellent short-term results, but the long-term outcomes of this approach remain unknown.

The current global health threat by the novel coronavirus disease 2019 (COVID-19) requires an urgent deployment of advanced therapeutic options available. The role of nanotechnology is highly relevant to counter this "virus" nano enemy. Nano intervention is discussed in terms of designing effective nanocarriers to counter the conventional limitations of antiviral and biological therapeutics. This strategy directs the safe and effective delivery of available therapeutic options using engineered nanocarriers, blocking the initial interactions of viral spike glycoprotein with host cell surface receptors, and disruption of virion construction. Controlling and eliminating the spread and reoccurrence of this pandemic demands a safe and effective vaccine strategy. Nanocarriers have potential to design risk-free and effective immunization strategies for severe acute respiratory syndrome coronavirus 2 vaccine candidates such as protein constructs and nucleic acids. We discuss recent as well as ongoing nanotechnology-based therapeutic and prophylactic strategies to fight against this pandemic, outlining the key areas for nanoscientists to step in.

We discuss the potential benefits, requirements, and implementation challenges of a security-by-design approach in which an integrated development environment (IDE) plugin assists software developers to write code that complies with secure coding guidelines. We discuss how such a plugin can enable a company's policy-setting security experts and developers to pass their knowledge on to each other more efficiently, and to let developers more effectively put that knowledge into practice. This is achieved by letting the team members develop customized rule sets that formalize coding guidelines and by letting the plugin check the compliance of code being written to those rule sets in real time, similar to an as-you-type spell checker. Upon detected violations, the plugin suggests options to quickly fix them and offers additional information for the developer. We share our experience with proof-of-concept designs and implementations rolled out in multiple companies, and present some future research and development directions.

Experimental research on the training of BLS instructors and how their performance evolves is scarce. This study investigated the role of content knowledge and repeated teaching trials for improving teaching and learning Basic Life Support (BLS).A cluster randomised controlled trial. Six secondary school teachers were assigned to either a common content knowledge (CCK) or specialised content knowledge (SCK) training. In the CCK group, teachers were taught to perform BLS technically correct. In the SCK group, teachers were additionally taught to detect and correct common errors students would make. Following the training, teachers taught two BLS lessons to two different classes of secondary school students (BLS performance was significantly higher in the second lesson for students taught by SCK versus CCK teachers (73% vs 63%). No significant difference was detected between lesson one and two across conditions and teachers. For cardiopulmonary resuscitation (CPR) variables, significant differences in favour of the SCK condition were found for chest compression depth after lesson one, and the amount and volume of ventilations after lesson two.Students' BLS and CPR performance was positively impacted by the SCK training. BLS performance varied greatly by teachers with averages ranging from 53% to 83% across conditions. Results suggest teaching experience alone is not sufficient to improve teaching effectiveness.

Molluscum pendulumgéant de la vulve sont des tumeurs bénignes, habituellement de petites tailles. Les lésions plus grandes sont rares et probablement attribuables à une prolifération de cellules mésenchymateuses au sein de la couche stromale sous-épithéliale sensible aux hormones du bas appareil génital. La taille de la lésion représente un préjudice fonctionnel et esthétique important. Cette tuméfaction rare discrète mérite d´être connue en raison de son retentissement fonctionnel et/ou de son évolution incertaine. Nous rapportons un cas d´une patiente de 38 ans, multipare G4P4V4 dont le dernier enfant a 1 an, elle a consulté le 05 décembre 2018 pour une grosse masse évolutive du pli inguinal gauche depuis 11 ans. L´interrogatoire n´a retrouvé aucun antécédent médico- chirurgical particulier. L´examen physique a retrouvé une molle, indolore, mobile par rapport au plan profond, et parsemée d´une macule hypo chromique cicatricielle (A et B). L'examen endo-anal a retrouvé des paquets hémorroïdaires non réductibles (B). L´hypothèse demolluscum pendulumgéant a été évoquée. Le bilan sanguin pré opératoire a objectivé un groupe sanguin B rhésus positif, la sérologie HIV était négative, le taux d´hémoglobine: 13,2g/l, le bilan d'hémostase faisable (TS-TC) était normal. Nous avons effectué une exérèse chirurgicale de la tumeur sous anesthésie générale. La pièce pesait 2500g (C). L´histologie a montré un tissu conjonctif œdémateux, myxoïde et richement vascularisé sans atypie cytonucléaire (D). Nous avons envoyé la patiente en hépato-gastro-entérologie pour la prise en charge de l´hémorroïde.

The aim of this paper is to propose a computation strategy for fatigue propagation simulation of a crack by taking into account the plasticity. Feulvarch et al. (Comput Methods Appl Mech Eng 361: 112805, 2020) recently proposed a first XFEM formulation capable of overcoming the volumetric locking phenomenon due to plastic incompressibility in 3D. This formulation is here applied to quadratic elements for the mode I propagation of a crack in a valve structure submitted to cyclic thermo-mechanical loading. A simulation strategy is proposed where it is not necessary to compute all the cycles and thus the complete plastic history. This is of great interest because it avoids the treatment of the possible closing of the crack and uses the conventional J-integral. The application reveals the interest of taking plasticity into account for the propagation accuracy.

Background The World Health Organization recommends regularly assessing the efficacy of artemisinin-based combination therapy (ACT), which is a critical tool in the fight against malaria. This study evaluated the efficacy of two artemisinin-based combinations recommended to treat uncomplicated Plasmodium falciparum malaria in Burkina Faso in three sites: Niangoloko, Nanoro, and Gourcy. Methods This was a two-arm randomized control trial of the efficacy of artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DP). Children aged 6–59 months old were monitored for 42 days. The primary outcomes of the study were uncorrected and PCR-corrected efficacies to day 28 for AL and 42 for DP. Molecular markers of resistance to artemisinin derivatives and partner drugs were also analysed. Results Of 720 children enrolled, 672 reached study endpoints at day 28, 333 in the AL arm and 339 in the DP arm. PCR-corrected 28-day per protocol efficacy in the AL arm was 74% (64–83%) in Nanoro, 76% (66–83%) in Gourcy, and 92% (84–96%) in Niangoloko. The PCR-corrected 42-day per protocol efficacy in the DP arm was 84% (75–89%) in Gourcy, 89% (81–94%) in Nanoro, and 97% (92–99%) in Niangoloko. No Pfk13 mutation previously associated with artemisinin-resistance was observed. No statistically significant association was found between treatment outcome and presence of the 86Y mutation in the Pfmdr1 gene. There was also no association observed between treatment outcome and Pfpm2 or Pfmdr1 copy number variation. Conclusion The results of this study indicate evidence of inadequate efficacy of AL at day 28 and DP at day 42 in the same two sites. A change of first-line ACT may be warranted in Burkina Faso. Trial Registry Pan African Clinical Trial Registry Identifier: PACTR201708002499311. Date of registration: 8/3/2017 https://pactr.samrc.ac.za/Search.aspx

Background: Blended learning combines online learning with face-to-face learning. Research investigating the effect of different blended learning models to teach basic life support (BLS) is lacking.Objectives: To investigate the effect of a mastery learning (ML) versus a self-directed learning (SDL) blend on students' BLS performance. In ML, students learn BLS as a linear sequence meaning each step should be 'mastered' prior to advancing to the next. In SDL, students' autonomy is increased for his or her learning trajectory leading to non-linear, user driven learning paths.Methods: A randomised controlled trial. Four conditions were created by combining two learning models (SDL and ML) in two learning phases (online and face to face). Bachelor students (n = 145) were randomised over these four conditions. In all blends, an online learning module was available for one week prior to a face-to-face learning component of which the duration was 45 minutes. All learners' BLS performance was assessed individually and unannounced one week following blended learning. An individual BLS score was calculated combining cardiopulmonary resuscitation (CPR) variables reported by a Laerdal ResusciAnne Manikin and qualitative observations by two trained researchers.Results: Students' CPR performance adhered to international 2015 guidelines for all groups. Median BLS-performance was 83.0% (interquartile range 13.2%). No statistical differences between groups were found for BLS performance or CPR variables.Conclusions: All blended learning models were highly time-effective since the face-to-face component only took 45 minutes and learning outcomes adhered to guidelines. ispartof: ACTA CARDIOLOGICA vol:75 issue:8 pages:1-7 ispartof: location:England status: Published online

The cardiovascular system is the first system in the body to reach a functional state, at around the 21st and 22nd day of gestation. As a result, any aortic arch anatomical variant results from the aberrant embryologic migration and/or differentiation of undifferentiated cardiac cell precursors. Initially, six paired aortic channels encircle the embryonic pharynx. They supply the developing pharyngeal arches and arise from the aortic sac. These channels run dorsally, embedded in the mesenchyme of the pharyngeal arches, and terminate in the right and left dorsal aortae.

This paper presents the characterization and design aspects of a novel fabrication method that integrates photolithography and self-folding to create polymer polyhedral structures. A two-step UV exposure process is used to produce patterned polymer films with flexible folds of low cross-linking density and stiff faces of high cross-linking density. Solvent is diffused into the folds during the development step of the photolithography process due to their low cross-linking density. The solvent concentration is non-uniform across the thickness of the folds and causes a strain gradient at these regions when the solvent is removed by heating the films, which enables self-folding. Experiments are performed to calibrate an equation that relates the dimensions of the folds and their achieved fold angle. An analytical model is introduced to elucidate the form of the equation and provide physical meaning to the calibration parameter. The formula is incorporated into a computational implementation of the unfolding polyhedra method that considers smoothly bent folds. This method, enhanced with the experimentally calibrated formula, enables the design of planar films programmed to self-fold into target three-dimensional shapes when heated. Polyhedral shapes are fabricated to demonstrate the developed method for origami-based fabrication. A parametric study quantifying the accuracy of the designed polyhedral forms with smooth folds as compared against those with idealized creased folds is performed.

Functional recovery for people with lower limb amputations is quantified using objective or subjective measures of performance. In this brief report, the prospective relationship between objective and subjective mobility after rehabilitation was evaluated in people with lower limb amputations. Adults undergoing inpatient prosthetic rehabilitation for a first unilateral transtibial or transfemoral level lower limb amputation were recruited. Assessment times: discharge and 4-mo follow-up. Gait velocity and the L Test under single- and dual-task conditions measured objective mobility. The Prosthetic Evaluation Questionnaire (section 4 and question 5b) measured subjective mobility. Paired t tests and Pearson correlation analysis evaluated change over time and the association between mobility types, respectively. Twenty-one people with lower limb amputations (61.6 ± 8.2 yrs) participated. Gait velocity significantly improved (single- and dual-task: P < 0.001). L Test significantly improved for single-task (P = 0.002) but not dual-task conditions. No statistically significant Prosthetic Evaluation Questionnaire changes were observed. One subjective mobility question (sidewalk walking) correlated with objective mobility at follow-up (L Test single- and dual-task: r = -0.77; P < 0.001). Objective mobility improved after discharge; however, subjective reporting had no change. Lack of association may represent a mismatch between quantitative outcomes and subjective self-assessment. Both subjective and objective measures of mobility should be collected to provide a holistic picture of clinical and patient-relevant outcomes in people with lower limb amputations.

Carbon microelectromechanical system (C-MEMS) and carbon nanoelectromechanical system (C-NEMS) have been identified as promising technologies for a range of biotech applications, including electrochemical biosensors, biofuel cells, neural probes, and dielectrophoretic cell trapping. Research teams around the world have devoted more and more time to this field. After almost two decades of efforts on developing C-MEMS and C-NEMS, a review of the relevant progress and addressing future research opportunities and critical issues is in order. This review first introduces C-MEMS and C-NEMS fabrication processes that fall into two categories: photolithography- and non-photolithography- based techniques. Next, a detailed discussion of the state of the art, and technical challenges and opportunities associated with C-MEMS and C-NEMS devices used in biotech applications are presented. These devices are discussed in the relevant sub-sections of biosensors, biofuel cells, intracorporeal neural probe, dielectrophoresis cell trapping, and cell culture. The review concludes with an exposition of future perspectives in C-MEMS and C-NEMS.

This paper presents a fabrication method for polymer films with programmable self-folding behavior. The target shape of the films is provided as a polygonal mesh. The unfolding polyhedra method is used to determine the layout of the folds and faces forming a planar origami sheet which can be folded towards the target shape. Photolithographic masks are printed with the determined layout and used in a photolithography process that produces polymer films with compliant folds of low cross-linking density and stiff faces of high cross-linking density. During the development step in the photolithography process, the films exhibit inhomogeneous developer absorption at the folds, with a higher concentration on the side of the folds that is in direct contact with the developer solution. The non-uniformly absorbed developer is removed upon heating the films, causing inhomogeneous strains across the thickness of the folds which leads to thermally-driven self-folding. The folded configuration of the films is made permanent by subsequently cooling the folded films to room temperature and saturating their cross-linking density through UV exposure. In the fabrication method, the fold angle achieved by each fold in the films is modulated by adjusting their width. A formula relating fold angle and fold width is calibrated using experimental data and incorporated into the computational implementation of the unfolding polyhedra method to precisely size the folds when creating the templates for the photolithographic masks. This method thus produces polymer films that are programmed to accurately self-fold into a target shape when heated. The fabrication method is demonstrated by producing various three-dimensional shapes. Potential applications of the fabricated programmable films include packaging of micro-systems and entrapment of cells.

Background: Individuals with diabetes mellitus (DM) are susceptible to balance, gait and cognitive impairments. Importantly, diabetes affects executive function, a set of cognitive processes critical to everyday cortical function and mobility. Reduced executive function is a risk factor for falls in people with DM. Dual-task testing, the completion of two tasks at once, enables the examination of the cognitive-mobility relationship. A synthesis of the literature on the effects of dual-task testing on the balance and gait of individuals with DM has not been performed. Objective: To systematically review the literature on the effect of dual-task testing on balance and gait in people with DM. Methods: Databases EMBASE, CINAHL, MEDLINE, PsycINFO, Scopus and Web of Science were searched (inception-April 2020). Inclusion criteria: participants were adults with a diagnosis of DM, instrumented dual-task balance and/or gait was assessed, and articles were published in English. Results: Ten articles met inclusion criteria- three examined dual-task balance and seven dual-task gait. In people with DM with or without peripheral neuropathy, dual-task resulted in larger sway velocities during standing tests. Individuals with DM and peripheral neuropathy had impaired dual-task gait; specifically, and more consistently, reduced pace and rhythm compared to controls or people with DM without peripheral neuropathy. Conclusion: The findings support a compromise in the cognitive-mobility relationship of people with DM, and especially in those with peripheral neuropathy. Future research should continue to examine the cognitive-mobility relationship in order to understand the increased prevalence of falls in this population.

BACKGROUND: Falls in older adults, notably those with Alzheimer's dementia (AD), are prevalent. Vision and balance impairments are prominent falls risk factors in older adults. However, recent literature in the cognitively impaired suggests that executive function (EF) is important for falls risk assessments. The study objectives were to: 1) to compare balance among people with AD, healthy older adults (OA), and healthy young adults (YA) and 2) to quantify the interaction of visual acuity and EF on postural stability. METHODS: We recruited 165 individuals (51 YA, 48 OA, and 66 AD). Trail Making Tests (A and B) quantified EF and the Colenbrander mixed contrast chart measured high and low contrast visual acuity. Accelerometers recorded postural sway during the Modified Test for Sensory Integration. A two-way repeated measures ANOVA examined postural sway differences across groups. Mediation analysis quantified the association of EF in the relationship between contrast sensitivity and postural sway. RESULTS: Significant EF and visual acuity between-group differences were observed (p

This paper introduces the concept of continuous chaotic printing, i.e. the use of chaotic flows for deterministic and continuous extrusion of fibers with internal multilayered micro- or nanostructures. Two free-flowing materials are coextruded through a printhead containing a miniaturized Kenics static mixer (KSM) composed of multiple helicoidal elements. This produces a fiber with a well-defined internal multilayer microarchitecture at high-throughput (>1.0 m min−1). The number of mixing elements and the printhead diameter determine the number and thickness of the internal lamellae, which are generated according to successive bifurcations that yield a vast amount of inter-material surface area (∼102 cm2 cm−3) at high resolution (∼10 µm). This creates structures with extremely high surface area to volume ratio (SAV). Comparison of experimental and computational results demonstrates that continuous chaotic 3D printing is a robust process with predictable output. In an exciting new development, we demonstrate a method for scaling down these microstructures by 3 orders of magnitude, to the nanoscale level (∼150 nm), by feeding the output of a continuous chaotic 3D printhead into an electrospinner. The simplicity and high resolution of continuous chaotic printing strongly supports its potential use in novel applications, including—but not limited to—bioprinting of multi-scale layered biological structures such as bacterial communities, living tissues composed of organized multiple mammalian cell types, and fabrication of smart multi-material and multilayered constructs for biomedical applications.

We herein report a high-resolution nanopatterning method using low voltage electromechanical spinning with a rotating collector to obtain aligned graphitized micro and nanowires for carbon nanomanufacturing. A small wire diameter and a small inter-wire spacing were obtained by controlling the electric field, the spinneret-to-collector distance, the pyrolysis parameters, the linear speed of the spinneret, the rotational speed of the collector. Using a simple scaling analysis, we show how the straightness and the diameter of the wires can be controlled by the electric field and the distance of the spinneret to the collector. A small inter-wire spacing, as predicted by a simple model, was achieved by simultaneously controlling the linear speed of the spinneret and the rotational speed of the collector. Rapid drying of the polymer nanowires enabled the facile fabrication of suspended wires over various structures. Patterned polyacrylonitrile wires were carbonized using standard stabilization and pyrolysis to obtain carbon nanowires. Suspended carbon nanowires with a diameter of

This paper introduces the concept of continuous chaotic printing, i.e., the use of chaotic flows for deterministic and continuous fabrication of fibers with internal multilayered micro-or nanostructures. Two free-flowing materials are coextruded through a printhead containing a miniaturized Kenics static mixer (KSM) composed of multiple helicoidal elements. This produces a fiber with a well-defined internal multilayer microarchitecture at high speeds (>1.0 m min-1). The number of mixing elements and the printhead diameter determine the number and thickness of the internal lamellae, which are generated according to successive bifurcations that yield a vast amount of inter-material surface area (~102 cm2 cm3) and high resolution features (~10 μm). In an exciting further development, we demonstrate a scale-down of the microstructure by 3 orders of magnitude, to the nanoscale level (~10 nm), by feeding the output of a continuous chaotic 3D printhead into an electrospinner. Comparison of experimental and computational results demonstrates the robust and predictable output and performance of continuous chaotic 3D printing. The simplicity and high resolution of continuous chaotic printing strongly supports its potential use in novel applications, including—but not limited to—bioprinting of multi-scale tissue-like structures, modeling of bacterial communities, and fabrication of smart multi-material and multilayered constructs.

Functional status is an important predictor of outcomes after infrainguinal bypass surgery. There are little data on the effect of functional status on the outcomes of endovascular lower extremity interventions, especially in the elderly frail population.This is a retrospective analysis of the American College of Surgeons - National Surgical Quality Improvement Program files for the years 2011-2013 to assess the impact of functional status on outcome after endovascular intervention for critical limb ischemia (CLI). Elderly patients (age ≥70) undergoing revascularization for CLI were included. The patients were divided into 2 groups based on functional status prior to surgery: independent (IND) or dependent (DEP), which included partially dependent as well as totally dependent patients. The 2 groups were compared with respect to demographics, comorbidities, complications, length of stay, limb loss, and mortality. Statistical analysis was performed using Student's t-test for continuous variables and Fisher's exact test for categorical variables.There were 1,055 patients (DEP = 253, 24%). There was no difference in gender or race but DEP patients were older than IND (P = 0.008). DEP patients were significantly more likely to have history of congestive heart failure (P = 0.003), hypertension (P = 0.042), and diabetes (P 0.001). There was no difference in emergent surgeries between the 2 groups (P = 1.00). DEP patients had more tibial interventions compared with IND (P 0.001). DEP developed more pneumonia (P 0.001) and septic shock (P = 0.016) and had a trend toward more urinary tract infections (P = 0.051) after endovascular revascularization. There was no significant difference in operating time (P = 0.232) or major amputation (P = 0.092). DEP had significantly longer length of hospital stay (P = 0.0068). DEP had significantly higher mortality (5.98% vs. 2.01%, P = 0.002). On multivariate analysis, DEP status, emergency procedure, congestive heart failure, cardiac arrest requiring cardiopulmonary resuscitation, myocardial infarction, sepsis, and septic shock were independently associated with 30 days of mortality. Irrespective of age, DEP functional status was the most significant preoperative predictor of mortality with an odd ratio of 5.16 [1.93-13.83], P = 0.001 (parsimonious model).Functional status should be carefully assessed when considering endovascular revascularization in the elderly as DEP has significantly higher morbidity and mortality.

The conventional fabrication process of carbon-based microelectromechanical systems (C-MEMS) often yields undesired carbon residues that reduce the reproducibility and performance of final structures by establishing unwanted electrical connections. In this work, we present a new and straightforward method based on the application of a low direct current (DC) to effectively remove the undesired electrical connections. The DC bias causes the breakdown and removal of the short-circuiting carbon residue due to Joule heating, resulting in significantly enhanced performance and reproducibility of the final structures. We fabricated carbon-based asymmetric coplanar interdigitated electrode arrays (IDEAs) for alternating current electroosmotic (ACEO) micropumps using the conventional Carbon-MEMS process. By scanning electron microscopy (SEM); Raman, energy dispersive X-ray (EDX) spectroscopies; four-point probe resistance measurements; and the combination of ion-beam etching and X-ray photoelectron spectroscopy (XPS), we confirmed the presence of residual carbon in the gaps of the IDEAs and established its deleterious effect on electrical properties of the structures and their performance as electrodes in micropumps. A computational study was also conducted to estimate the temperature increase due to the DC bias applied across a thin residual carbon. Experimentally, we found that the DC-treated IDEAs exhibited more than double the fluid velocity in ACEO pumping compared to untreated devices; and also, the coefficient of variation of the fluid velocity for the DC-treated ACEO micropumps was significantly smaller than that for the untreated ones. This simple and easy-to-implement method can substantially improve the yield of Carbon-MEMS manufacturing, leading to a highly reproducible production of high performance carbon electronic circuits and microstructures.

While 3D printing is increasingly used in most fields of engineering, its utilization for microfluidics has thus far been limited. To demonstrate future applications of 3D printing for microfluidic structures, we investigate the fluidic characteristics of material jetted surfaces. We also demonstrate the manufacture of dual-material microfluidic inserts that feature rigid and elastic elements. The fabricated parts are inserted on a microfluidic CD, enhancing design freedom and prototyping capability of over molded parts. Furthermore, printed elastic membranes are tested for fatigue during elastic-pneumatic pumping and rigid and elastic surfaces are characterized with regards to hydrophilicity and surface topography. Finally, different printed disc inserts are demonstrated for moving liquid towards the center of rotation, the mixing of liquids, and controlling burst events through channels width.

This study compares fluid velocity magnitude and direction for three different glassy carbon (GC) electrode systems effecting alternating current (AC) electroosmotic pumping. The flow behavior is analyzed for electroosmotic pumping performed with asymmetric coplanar electrodes. Subsequently, effects of adding microposts array of two different heights (40 μm and 80 μm) are studied. Experimental results demonstrate that as peak-to-peak voltage is increased above 10 V peak-to-peak, the flow reversal is achieved for planar electrodes. Utilization of microposts-enhanced asymmetric electrodes blocks the flow reversal and alters the magnitude of the fluid velocity at the application of larger voltages (above 10 V peak-to-peak). Understanding of the consequences of three-dimensional geometry of asymmetric electrodes would allow designing the electrode system for AC electroosmotic pumping and mixing, as well as bidirectional fluid driving with equal forward and backward flow velocities.

Novel biomarkers and lower limits of detection enable improved diagnostics. In this paper we analyze the influence of flow on the lower limit of electrochemical detection on a microfluidic Compact Disc (CD). Implementing wireless transfer of data reduces noise during measurements and allows for real time sensing, demonstrated with the ferri-ferroyanide redox-couple in single and dual mode cyclic voltammetry. The impact of flow on redox-amplification and electrode integration for the lowest limit of detection are discussed.

Based on the concept of LEGO toys, a fiber probe analytical platform (FPAP) was developed as a powerful diagnostic tool offering higher sensitivity in detection of infectious agents compared to established methods. Using the form and the function of LEGO toys, this protocol describes a fiber-based, 96-well plate, which suspends a new class of chemically-designed, electrospun fibers within the assay. This clamping strategy allows both sides of the developed fiber mats to interact with biomolecules within the assay thus benefiting from the tailored chemical and physical properties of these fiber-based bioreceptors in attracting the biomolecules to the surface. The fabrication method of FPAP involves one-step electrospinning of the chemically designed fibers, 3D printing of the LEGO-like probing segments, and assembly of the device followed by ELISA procedure. FPAP follows the same principles of operation as that of a conventional enzyme linked immunosorbent assay (ELISA), therefore, it can be run by lab technicians, expert in ELISA. FPAP was used for early diagnosis of Dengue fever and provided an 8-fold higher sensitivity while the limit of detection (LOD) was recorded to be in femto-gram per milliliter range which is significantly low when compared to other existing techniques or conventional assay. This platform allows different types of paper/fiber bio-receptive platforms to be incorporated within the design that promises simultaneous recognition of multiple infectious agents.

Introduction Enhanced Recovery after Cardiac Surgery (ERACS) pathways can increase patient satisfaction, reduce the length of hospital stay and stay in the intensive care unit. The reported incidence of acute kidney injury (AKI) after cardiac surgery varies from 2.5% to 40% and is associated with an increased 30-day mortality¹. We examined the effect of ERACS on the total amount of fluid administered and the incidence of AKI. Methods We retrospectively analyzed prospectively collected outcome data of patients undergoing cardiac surgery enrolled in the ERAS pathway (n = 107) compared to a historical standard care group (n = 173). The ERAS pathway included pre-operative patient education, multimodal pain management to minimize opioid usage, carbohydrate loading 2-4hrs before induction of anesthesia, tight glucose control, early postoperative invasive access and chest tube removal, early extubation, and early mobilization. Intraoperatively, 500mL of the cardiopulmonary bypass (CBP) priming fluid was replaced with albumin 5% and the patients received 250mL albumin 5% before initiation and 250mL after separation from CBP. Crystalloid boli were administered in the intensie care unit (ICU) for clinical signs of hypovolemia, increasing pressor requirements or worsening metabolic acidosis. The standard care group was treated per preexisting institutional guidelines. AKI was defined using modified KDIGO (Kidney Disease Improving Global Outcomes) criteria, patients with pre-existing renal injury were excluded. Data were compared using univariate analysis: parametric and non-parametric data were analyzed with Student's t-test and Wilcoxon rank-sum test, respectively. A p-value of less than 0.05 was considered statistically significant. Results The mean (SD) creatinine pre-operatively, at discharge, and the peak creatinine were not different between the ERACS and the standard care group (table). Less fluid was administered in the ERACS group, but the total fluid balance was not different. No significant difference exists between the occurrence of AKI between those groups; no patient developed AKI worse than KDIGO stage 1 (modified). Discussion Although the ERACS patients received less fluid than the standard care group during the hospital stay, the incidence of AKI did not differ, nor did the serum creatinine at discharge between both groups. A restrictive fluid management with intraoperative albumin administration does not increase the incidence of acute kidney injury for patients in the ERACS pathway.

We present a novel magnetic valving technology designed for lab-on-compact disc (CD) platforms. The working principle is based on a movable plug that, under the effect of the centrifugal force, can close off a channel. The channel can be reopened using magnetic force acting on the plug to lift off the plug from the valve seat. Different geometries and materials for the valve have been compared to optimize the manufacturability, closing (sealing), and opening properties of the valve. Among several materials tested as a valve seat, polydimethylsiloxane was found to be the best choice. Characterization and theoretical analysis of the implemented magnetic valve show that it can be efficiently used as an on–off active valve for a wide range of rotational frequencies. A theoretical model for description of the sealing properties of the valve was proposed and experimentally validated. [2014-0207]

Microfluidic CD platforms are utilized to perform different biological processes and chemical analyses. In general, a microfluidic CD implements the centrifugal force that is created by the spinning of the platform to pump liquid through the microfluidic network of chambers and channels. Over the last few decades, a wide range of active and passive valving methods were proposed and tested on various microfluidic platforms. Most of the presented valves are too complex to design and involve lengthy fabrication processes. In this paper, easy to fabricate air and liquid check valves for centrifugal microfluidic platforms are presented: a Terminal Check Valve (TCV) and a Bridge Check Valve (BCV). To understand the characteristic of the proposed valves, theoretical and experimental studies are conducted. Moreover, to test the effectiveness of these valves, liquid swapping is demonstrated by integrating TCV and BCV chips with thermo-pneumatic (TP) pumping on a CD. The valves are shown to accurately control flow direction which makes them an excellent choice for a variety of complex microfluidic processes. The experimental and theoretical results also indicate that these valves require low pressure for actuation. Furthermore, the theoretical results confirm the ability to adjust the required actuation pressure by changing the valve chip size. Finally, as a proof of concept for implementing the check valves on a biological application, an enzyme linked immunosorbent assays (ELISA) is performed. The result shows that the TCV and BCV valving chips enhance the operating range of the processes that can be performed on the microfluidic CD.

Objectives: To evaluate therapeutic and prognosis of Uretero-pelvic junction abnomalities. Methods: This article was retrospective and descriptive, covering a period of six months, running from January 1st to December 31st, 2013 and conducted to evaluate therapeutic and prognosis of Uretero-pelvic junction abnormalities. Included criteria were all patients whose diagnosis was abnormalities of the uretero-pelvic junction and had been confirmed after para clinical explorations. The stricture of the junction after a first kidney surgery did not include. The Creatinine level has considered high from 15 mg/l. Results: The median age was 35 years old. Age groups (30 - 40) years old have predominated in 36.2%. A male predominance had been noted in 62.3% versus 37.7% women. The most affected occupation was the officials in 37.7% of cases. The main reason for consultation was lumbar pain in 97.1%. The high creatinine level has observed in 19 patients (27.5%). Sixty-one patients (88.41%) have been operated. An abstention has been observed in 7 patients (10.14%) and one patient died before the surgical issue in renal failure. The early post-operative course has been uneventful in 78.7% (48 cases) and complicated in 21.3% (21 cases). Conclusions: Open surgery tends to disappear at the expense of the endopyelotomy and laparoscopy which gives best results. However, it is still relevant.

International audience; Purpose Cases of fracture-fixation device infection involving Staphylococcus lugdunensis are not frequent. The clinical characteristics and the choice of treatment strategies of these infections are not obviously known to date. Methods We performed a review of fracture-fixation device infection involving S. lugdunensis managed by our centres. Results Among the 38 cases of fracture-fixation device infection involving S. lugdunensis, 53% were located in the tibia. Most of our cases (87%) were chronic infections. Purulent discharge, which occurred in 79% of cases, was the most frequent clinical symptom, followed by pain in 63%, local inflammation in 55%, and fever in 37%. Bacteremia and severe sepsis occurred in 10% and 18% of cases, respectively. Four cases (10%) were treated exclusively with antimicrobial treatment alone. Thirty-four cases (89%) were treated with a combination of surgery with antimicrobial therapy including surgical debridement, antibiotics and osteosynthesis device retention in six cases (16%), and osteosynthesis device removal in 27 cases (71%). The mean length of antibiotic treatment was 119 days. The relapse rate was high that was not related to selection of resistant strains. Polymicrobial infection had no impact on clinical outcome. A combination of surgery with antimicrobial therapy was identified as a significant prognostic factor associated with remission (p = 0.042). Conclusions S. lugdunensis is probably involved in more infections than has been reported. Using appropriate microbiological methods laboratories should routinely identify the species of all coagulase-negative Staphylococci isolates involved in fracture-fixation device infection to better achieve the treatment strategies of fracture-fixation device infection involving S. lugdunensis.

Cardiac surgery for radiation-induced valvular disease is associated with adverse outcomes. Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with radiation-induced aortic stenosis (RIAS). The aim of this study was to examine outcomes of TAVR compared with surgical

Introduction Enhanced Recovery After Surgery (ERAS) pathways have been proven to increase patient satisfaction scores, decrease the complication rate, decrease the length of stay (LOS), and decrease cost for many surgical specialties. Recently, ERAS for cardiac surgery guidelines have been published and are being implemented in many centers. However, few data are reported on clinically important outcomes. We examined the effect of ERAS for cardiac patients on the duration of mechanical ventilation, ICU and hospital LOS.¹ Methods We retrospectively analyzed prospectively collected outcome data of patients undergoing cardiac surgery enrolled in the ERAS pathway (n = 115) compared to a historical standard care group (n = 188). The ERAS pathway included pre-operative patient education, multimodal pain management to minimize opioid usage, carbohydrate loading 2-4hrs before induction of anesthesia, minimizing crystalloid infusions, tight glucose control, early postoperative invasive access and chest tube removal, early extubation, and early mobilization. The standard care group was treated per preexisting institutional guidelines. Data were compared using univariate analysis: parametric and non-parametric data were analyzed with Student's t-test and Wilcoxon rank-sum test, respectively. A p-value of less than 0.05 was considered statistically significant. Results The median (25th, 75th) intensive care unit (ICU) length of stay (LOS) was 1 day (1, 2) in the ERAS group and 2 days (1, 3) in the standard care group (p Discussion The Enhanced Recovery Pathway after Surgery pathway uses a standardized approach to perioperative patient care. Implementation of ERAS for cardiac surgery results in shorter ICU and hospital LOS, comparable ICU and 30-day readmission rates, without a noticeable increase in 30-day mortality. Further studies focusing on other relevant outcome parameters are warranted.

Controlled bidirectional flow by AC electroosmotic means is achieved using asymmetric coplanar and high-aspect-ratio glassy carbon electrodes and without the involvement of moving elements. The forward and backward fluidic propulsion is the result of hydrodynamic channeling of the fluid in a microfluidic device. The asymmetric coplanar electrodes were fabricated by photolithographic patterning of SU-8 photoresist, followed by pyrolysis at 900 °C. Morphological characterization of the carbon structures was carried out by SEM and confocal microscopy. Then, Raman and EDX spectroscopies confirmed that the resulting carbon material is appropriate for electrokinetic applications. A finite element analysis was carried out to study the flow development by AC electroosmosis. Electrode arrays of three different asymmetry ratios (60 µm:20 µm, 80 µm:20 µm, and 100 µm:20 µm) were fabricated and tested. Fluid velocity was measured for an applied bias in the 2–20 V PP amplitude range, and in the 1 kHz to 200 MHz frequency range. Overall maximum measured forward and reverse fluid velocities were 28.59 µm s−1 and 338 µm s−1, respectively. On an additional set of devices with the same asymmetry ratios, a second photolithography step was utilized to produce high-aspect-ratio microposts on top of the coplanar electrodes to study the effect of high electrode contact surface to generate bidirectional flow. Using the same amplitude and frequency ranges as for planar structures in experimental testing, the overall maximum measured velocities were 9.23 µm s−1 and 90.66 µm s−1 for the forward and reverse regimes, respectively. In contrast to the planar electrodes, microposts-containing electrodes had more balanced velocity magnitudes between reverse and forward flows as the asymmetry ratio increases. In this case, the use of this electrode topology can be useful when symmetry of the forward and backward flow is more important than the magnitude of the volumetric flow rate.

This paper presents a theoretical development and critical analysis of the burst frequency equations for capillary valves on a microfluidic compact disc (CD) platform. This analysis includes background on passive capillary valves and the governing models/equations that have been developed to date. The implicit assumptions and limitations of these models are discussed. The fluid meniscus dynamics before bursting is broken up into a multi-stage model and a more accurate version of the burst frequency equation for the capillary valves is proposed. The modified equations are used to evaluate the effects of various CD design parameters such as the hydraulic diameter, the height to width aspect ratio, and the opening wedge angle of the channel on the burst pressure.

Manufacturing technology today may be compared with computer technology 40 years ago, epitomized by large centralized “mainframe” facilities. The proliferation of desktop computing ushered in a new age of access that revolutionized how we communicate, do business, and socialize. The world economy flourished with new jobs – in software, peripherals, and even furniture and accessories – to support this new infrastructure. We suggest that a possible scenario for the future of manufacturing is to emulate this transformation from the mainframe to networked PCs by migrating from centralized factories to distributed, networked Desktop Integrated Manufacturing Platforms (DIMPs). In this vision a DIMP is envisioned as a single or interconnected group of manufacturing processing units/machine(s) forming an autonomous entity that executes complex hybrid manufacturing processes. DIMPs could be physically connected or distributed and coordinated via, for example, the Internet. Depending on the manufacturing task and process compatibility, multiple DIMPs can be interconnected through a common “bus” carrying materials, energy, and control signals. Several multi DIMPs can thus be further interconnected, perhaps regardless of location, to form a network or “Internet of distributed DIMPs.”

We review the utility of centrifugal microfluidic technologies applied to point-of-care diagnosis in extremely under-resourced environments. The various challenges faced in these settings are showcased, using areas in India and Africa as examples. Measures for the ability of integrated devices to effectively address point-of-care challenges are highlighted, and centrifugal, often termed CD-based microfluidic technologies, technologies are presented as a promising platform to address these challenges. We describe the advantages of centrifugal liquid handling, as well as the ability of a standard CD player to perform a number of common laboratory tests, fulfilling the role of an integrated lab-on-a-CD. Innovative centrifugal approaches for point-of-care in extremely resource-poor settings are highlighted, including sensing and detection strategies, smart power sources and biomimetic inspiration for environmental control. The evolution of centrifugal microfluidics, along with examples of commercial and advanced prototype centrifugal microfluidic systems, is presented, illustrating the success of deployment at the point-of-care. A close fit of emerging centrifugal systems to address a critical panel of tests for under-resourced clinic settings, formulated by medical experts, is demonstrated. This emphasizes the potential of centrifugal microfluidic technologies to be applied effectively to extremely challenging point-of-care scenarios and in playing a role in improving primary care in resource-limited settings across the developing world.

International audience; no abstract

This study aimed to determine the whole-body vibration (WBV) frequencies that cause the highest average electromyogram (EMG) output in four different muscles, in relation to patients suffering from multiple sclerosis (MS), and to what extent the loads were acceptable. In a series of measures using different WBV frequencies applied to five MS patients, the effects on EMG output (in μV) and the rate of perceived exertion (RPE; scale, 6–20) were studied. All measurements were performed on two different WBV devices: the ZeptorMed™ and the Galileo2000 ® . The physical loads were well accepted, with a highest average rate of perceived exertion of 12.8 during the 29-Hz application. With the Galileo2000 ® , the highest EMG results were obtained at 29 Hz in the vastus medialis and lumbar muscles, at 25 Hz in the gastrocnemius medialis, and at 19 Hz in the tibialis anterior muscle. The results with the ZeptorMed™ were more consistent at 11 Hz and 12 Hz, but the EMG output was lower. In conclusion, the physical loads of WBV were well accepted by the MS patients. However, the most effective frequencies are device specific and should be determined for each subject and for each individual muscle or muscle group.

We propose a novel and simplified method to fabricate complex 3-dimensional structures in SU-8 photoresist using maskless grayscale lithography. The proposed method uses a Digital Micro-mirror Device (DMD ® ) to modulate the light intensity across a single SU-8 photoresist layer. Top and back-side exposure are implemented in the fabrication of original structures such as cantilevers, covered channels with embedded features and arrays of microneedles. The fabrication of similar structures in SU-8 with other techniques often requires complex physical masks or the patterning of several stacked layers. The effects of critical process parameters such as software mask design, exposure and developing conditions on the quality of 3-D structures are discussed. A number of applications using bridges, cantilevers and micromixers fabricated using this methodology are explored.